Ability, Incentives, and Management Feedback: Organizational Change to Reduce Pressure Ulcers in a Nursing Home

Rosen, Jules; Mittal, Vikas; Degenholtz, Howard; Castle, Nick; Mulsant, Benoit H.; Hulland, Shelley; Nace, David; Rubin, Fred

doi:10.1016/j.jamda.2005.08.003

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Volume 7, Issue 3 , Pages 141-146, March 2006

Ability, Incentives, and Management Feedback: Organizational Change to Reduce Pressure Ulcers in a Nursing Home

Jules Rosen, MD
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Address correspondence to Jules Rosen, MD, University of Pittsburgh, School of Medicine, WPIC, 3811 O’Hara Street, Pittsburgh, PA 15241
Vikas Mittal, PhD
- Katz Graduate School of Business and Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
Howard Degenholtz, PhD
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
Nick Castle, PhD
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
Benoit H. Mulsant, MD
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Geriatric Research, Education, and Clinical Center, VA Pittsburgh Health Care System, Pittsburgh, PA
Shelley Hulland, MBA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
David Nace, MD
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
Fred Rubin, MD
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA

published online 12 December 2005.

Objective

Quality improvement (QI) processes in nursing homes are highly variable and often ineffective. This study evaluated an innovative QI process to reduce pressure ulcers (PUs) in a nursing home with a high rate of PUs.

Design

This was a 48-week, longitudinal study comparing the incidence of PUs during 12-week baseline and intervention and post-intervention periods.

Setting

Not-for-profit, 136-bed nursing home in urban Western Pennsylvania.

Patients or Other Participants

All residents and all staff at the nursing home participated in this study.

Interventions

The intervention consisted of 3 components: Ability enhancement, incentivization, and management feedback. To enhance ability, all staff members completed a computer-based interactive video education program on PU prevention and were mandated to use penlights to promote early detection. Incentivization included $75 for each staff member if the desired reduction in PU incidence was achieved. Management feedback provided real-time information of staff”s adherence to the mandated training.

Main Outcome Measures

Outcome measures consisted of staff’s adherence to mandated training and the incidence of new PUs during the baseline period compared to the intervention and post-intervention periods.

Results

Management responded to noncompliance with training with both rewards and stepped discipline. Adherence to protocol, as measured by training compliance, was 100%. There was a significant reduction (P < .05) in the incidence of stage 2 or worse PUs during the intervention period. During the post-intervention periods, the effect was lost.

Conclusion

An innovative QI initiative resulted in a significant decrease in PUs in 1 facility. This intervention was not sustainable when the 3 components of the QI intervention were no longer actively maintained.

Keywords: Nursing home , pressure ulcer , quality improvement , organization